93 Decision Citation: BVA 93-12569
Y93
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
DOCKET NO. 92-12 354 ) DATE
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THE ISSUES
Entitlement to service connection for a liver transplant
secondary to end stage liver disease resulting from viral
hepatitis.
REPRESENTATION
Appellant represented by: Disabled American Veterans
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
L. L. Gann, Associate Counsel
INTRODUCTION
This matter has come before the Board of Veterans' Appeals
(Board) on appeal of an August 1990 rating decision of the
Boston, Massachusetts, Regional Office (RO). The notice of
disagreement was received in November 1990. A statement of
the case was issued in February 1991. The veteran submitted
a substantive appeal in March 1991. A hearing was held
before a hearing officer of the Department of Veterans
Affairs in April 1991. The hearing officer rendered his
decision in December 1991. Supplemental statements of the
case were issued in February and April 1992. The case was
received and docketed at the Board in July 1992. The
Disabled American Veterans submitted written argument in
November 1992.
The veteran had active service from April 1969 to November
1970. He served in the Republic of Vietnam from September
1969 to November 1970.
After review, it is our judgment that the record may not yet
be ready for a final appellate decision on the merits of
entitlement to the benefits sought on appeal.
REMAND
The veteran contends that end-stage liver disease resulting
from viral hepatitis incurred while stationed in the
Republic of Vietnam ultimately necessitated a liver
transplant procedure in May 1990. His service medical
records indicate that he was treated for symptoms of dry
cough, fever, malaise, chills, rhinorrhea, diarrhea and
generalized myalgia in November 1970. Tests for malaria
were negative. In July 1971, he sought treatment for
similar symptoms at the Group Medical Practice in Santa
Rosa, New Mexico. At the time, he attributed these symptoms
to a relapse of malaria. He also maintains that he sought
treatment for these symptoms at the VA Medical Center in
Albuquerque, New Mexico, in 1970 and 1971. Although several
attempts have been made to acquire these records, requests
for information have been met with no response.
Neither the service medical records nor medical records
available prior to 1988 indicate treatment for, or a
diagnosis of viral hepatitis. In April 1991 and February
1992 statements, however, Dr. Lewis, who performed the
veteran's liver transplant, opines that the veteran's liver
disease was the result of hepatitis incurred most probably
during his service in Vietnam. He based these statements
upon the service medical records, the veteran's subsequent
treatment, and his own knowledge of the 10 to 30 year elapsed
time period between onset of viral hepatitis and the end-stage
of liver disease. September 1988 treatment records from the
Harvard Community Health Plan indicate the presence of
hepatitis B virus, but do not elaborate on the status or the
history of the disease.
We note, however, that the hospitalization and treatment
records for the veteran's liver transplant of May 1990 at
Deaconess Hospital in Boston, Massachusetts, have not been
associated with his claims file. These records are relevant
in determining the etiology of the veteran's condition, as
well as the extent of the liver disease process prior to organ
transplant.
Moreover, the veteran has not been afforded a comprehensive VA
examination by a specialist in diseases of the liver, pancreas
and spleen which addresses the specific history and etiology
of his liver condition. Although a VA examination was
performed in June 1991, this examination was not particularly
comprehensive, inasmuch as there were no blood test results
associated with the examination report, nor does it appear
that the examining physicians reviewed the entire medical
record prior to rendering their findings. Furthermore, the
veteran has acknowledged that he regularly used alcohol until
1987, sometimes drinking as much as 5 or more sixpacks of beer
a week. It is not clear what effect this alcohol consumption
had upon the severity or rapidity of his liver disease process.
The Board is of the opinion that additional development
concerning the history and etiology of the veteran's liver
disease is required. Accordingly, the case is REMANDED for
the following action:
1. The RO should again request the VA
Medical Center in Albuquerque, New
Mexico, to submit all records of the
veteran's treatment for the period of
1970 and 1971. If these records are
unvailable or are duplicates of those
already on file, that fact should be
annotated in the claims folder.
2. The RO should contact both the
Deaconess Hospital and Dr. David
Lewis, M.D., 110 Francis Street,
Suite 8C, Boston, Massachusetts 02215,
to obtain copies of all hospitalization
and treatment records associated with
the veteran's liver transplant, which
was performed in May 1990. These
records should include copies of
patient histories, diagnoses, and
procedures undertaken, in addition to
pre- and post-operative consultation
records. The RO should also request
that copies of all pertinent private
office and outpatient records for the
period preceding the May 1990 surgical
procedure be submitted by Dr. Lewis.
3. Once the RO is in receipt of all
requested records, it should arrange
for the veteran to be examined by a
board-certified hepatologist to
determine the etiology of his liver
disease. The physician should be
instructed to perform blood tests to
determine past exposure to viral
hepatitis and malaria, obtain a full
medical history from the veteran, and
review all medical evidence, including
service medical records and sworn
hearing testimony, in order to render a
comprehensive evaluation. He should
also be instructed to determine what
effect the veteran's alcohol
consumption had upon the nature and
severity of his liver disease. The
examination report must contain results
of all laboratory tests ordered, and
complete rationale for all conclusions
recorded.
When this development has been completed, the RO should
readjudicate the issue of service connection for a liver
transplant secondary to end-stage liver disease resulting
from viral hepatitis. If the decision remains adverse to
the appellant, he and his representative should be furnished
a supplemental statement of the case and afforded a
reasonable opportunity for reply.
The purpose of this REMAND is to comply with our duty to
assist the appellant in developing his claim.
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
W. H. YEAGER, JR., M.D. C. P. RUSSELL
*
*38 U.S.C.A. § 7102(a)(2)(A) (West 1991) permits a Board of
Veterans' Appeals Section, upon direction of the Chairman of
the Board, to proceed with the transaction of business
without awaiting assignment of an additional Member to the
Section when the Section is composed of fewer than three
Members due to absence of a Member, vacancy on the Board or
inability of the Member assigned to the Section to serve on
the panel. The Chairman has directed that the Section
proceed with the transaction of business, including the
issuance of decisions, without awaiting the assignment of a
third Member.
Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United
States Court of Veterans Appeals. This remand is in the
nature of a preliminary order and does not constitute a
decision of the Board on the merits of your appeal with
respect to the issues so remanded. 38 C.F.R. § 20.1100(b)
(1992).